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Full text of "Medicaid and you"


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Medicaid was 
established by 
Congress in 
1965 as part 
of the SOCIAL 
SECURITY ACT. 



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A SCRIPTOGRAPHIC BOOKLET by CHANNING L. BETE CO., INC., South Deerfield, MA 01373 U.S.A. 
©1979 All rights reserved. Tel. 1-413-665-761 1 1983 Edition 1656C-6-83 




You 

You may have high 
medical bills, an unex- 
pected drop in income, 
etc. Or you may need 
Medicaid now. 



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Because-- 

YOU no,? 
FAY fdp- \T 

You pay through 

• federal income taxes 

• state taxes 
(income, sales 
taxes, etc.) 

• local taxes 
(property tax, etc.) 




evepYojje 

ffLOIA tt 

Directly or indirectly, 
Medicaid helps all 
Americans by reducing 
disease and disability. 




yfcT--rw3ny people 

about- /Medicaid, 





G>, ^ - " 





PAYS 

-for '*? 



6ACH PAWjciPATi^G STATg, 

(plus the Virgin Islands, Puerto Rico, 
the District of Columbia, Guam, and 
the Northern Mariana Islands) 

-through '3-- 

• 3TA1X w£i^aa£ OPPtce 

• 9U&U& HEALTH OF?i&£ 

• soc4au service oFF'C£,or 

• j&rA-rg ^eaicAip o^ce 

you CAfJ PHD OUT 

about your state's plan at your local 
public health or welfare office. 







Mill : IM£A IM : - ] ^ 




A 7f 







pays over half of all Medicaid 
costs -- 55% nationally. 



.£TAfT£S 

pay 22% (poorest 
state) to 50% (richer 
states) of costs. 



U>CAUTAS fuMQC, 

contribute in some 
areas. 



Anyone MAY APPty 
fop- MCpiCAiP 

Yotr sk>ulj 3pply especially if-- 




Vou have 

pepe^peHr 

-and your 
income 
i& low. 



You nave 

COSTS /^ 

in relation f j~ 




Vou -are, 
A660, &HNP 

or aisABteo 

W»+U I ifHe or no 
income,. 



HoW to APP^Y 

y©u m^ comple+e -a FoP-fA provided by +ne s-t-a+e. 
(Information is confidential.) 



W^ere +0 30. 



ASK AT YOUR LOCAL WELFARE 
OR SOCIAL SECURITY OFFICE. 

In most states you can apply at your 
local state welfare, public health, or 
social service agency. 

In some states aged, blind and dis- 
abled people can apply through the 
local Social Security office. 

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YOU'LL NEED PROOF OF 

• INCOME LEVEL (paystubs, other 
evidence of your income and that 
of relatives living with you (also 
bankbooks, other evidence of sav- 
ings or assets). 

• U.S. CITIZENSHIP 

• PERSONAL CIRCUMSTANCES 
(proof of age, unemployment, 
absence of one parent, etc.) 

• DISABILITY, if any (bring medical 
records). 



"tUft 3+3+e VMS* nvake 1 decision 3Docrf- your eligibility 

wi+n'm 45 days-- bo days rF you're- disabled- 

If you apply through the Supplemental Security Income Program (SSI) 

there's no time limit. 

You also have the right to appeal the state's decision. 



WMO'S 

-tor AAeJicdi J 



weae, people 3re eligible 
for .s+3-te MeJic^iJ 
progr3rA£ by federal 



(Aid to Families with Dependent Children) 



# ;? 



those receiving 
cash assistance 
through AFDC 
qualify. 



• also iHCLooee 

individuals who are 
deemed to be AFDC 
recipients. 




A6CP, &ur*o op- piSABuep pe,p&ot*s 



• iH t*o£rr &vpres* 

people receiving cash 
benefits from the SUP- 
PLEMENTAL SECURITY 
INCOME PROGRAM 
(SSI) because of age, 
blindness or disability. 



* Alabama 
Alaska 
Arizona 
Arkansas 
California 
Colorado 
Delaware 
District of 
Columbia 
Florida 
Georgia 
Idaho 
Iowa 



Kansas 
Kentucky 
Louisiana 
Maine 
Maryland 
Massachusetts 
Michigan 
Montana 
Nevada 
New Jersey 
New Mexico 
Northern Mariana 
Islands 



Oregon 
Pennsylvania 
Rhode Island 
South Carolina 
South Dakota 
Tennessee 
Texas 
Vermont 
Washington 
West Virginia 
Wisconsin 
Wyoming 



• IN CfTneiL STficTSS** 

people who meet 
certain STATE STAN- 
DARDS for disability, 
income and re- 
sources which 
are stricter than 
federal SSI 
standards. 




Connecticul 
Guam 
f^) Hawaii 
Illinois 
Indiana 
Minnesota 
Mississippi 
Missouri 
Nebraska 
New Hampshire 
New York 
North Carolina 
North Dakota 



Ohio 

Oklahoma 

Puerto Rico 

Utah 

Virgin Islands 

Virginia 



0+l*er people r*3y be inclujeJ in 



people venose in<w*6 
APTep- /wepic^u e*pewses 

is below a certain level 

set by their state, even 

though they do not 

qualify for AFDC or 

SSI. They are termed ^L' r y * < 

"medically needy." <z> 



^% 



PeopLG. I/O /VAepiaAL 
INSTiTJTiO/06 

whose income 
covers their needs, 
but who would be 
eligible for cash 
assistance if living 
in the community. 




people vho p-eceive 

pfPlCHtO ATAT6 3UPPteM6/^T- 
AtLV PAYMENTS 

provided their income 
is not more than 3 
times the level of 
SSI benefits. 




people, who wouup ae, 
Not APpuep /■ ,N 

for AFDC, /^nAt / 

SSI or state Q<^ ^^ 
supplementary W- 
payments. 




PfcOpLfc WHO \fiJOUL,0 

be eutei&u& pop. 

APPC/ 

6*cept--- 

< 
• their state's program 
is not as high as 
the Social Security 
Act allows (for 
example, to families 
with unemployed 
parents). 




they are not considered "dependent 
children " (for example, people between 
18 and 21 who meet income limits but 
live independently). 



• they receive child care services 
through an agency, but would meet 
income requirements if they had 
to pay for it. 



* Some of the above groups are covered in: 

Maryland New Hampshire Pennsylvania Virgin Isands 

Massachusetts New York Puerto Rico Virginia 

Michigan North Carolina Rhode Island Washington 

Minnesota North Dakota Tennessee West Virginia 

Montana Northern Mariana Utah Wisconsin 

Nebraska Islands Vermont 

Oklahoma 



Arkansas 


Hawaii 


California 


Illinois 


Connecticut 


Kansas 


District of 


Kentucky 


Columbia 


Louisiana 


Guam 


Maine 




MeJic^cl pten< 

BASIC M£0| 

in most states j for-. 

• people receiving -federally r 

• certain ^medically needy" \ c 
(Coverage may not be as I 

Amounts and duration of co' ft 



'-'■ room and board, 
operating room fees, 
delivery room, X-ray, 
lab tests, medication 
given during hospital 
stay, etc. 




O0TPfiTiej*T 

rfoSPiTfil> 

56f2-VfC&£ 

-- treatment, 
X-rays, 
tests, etc 




ourpfixtet*T 
W&otLflrop.y, 

SCP*\C£S> 



IV— I 




2nd tame. 

ke'al+k services 

for those 
21 and over. 




Ml ©, 



-- physicians' charges^~N C 
for office visits, ( I t/J 
care given in hos- v- // 
pitals, treatment in 
hospital outpatient 
departments. 




services (y^) 




Transportation to and from services must be assured. 




>ver a+- leasf 4*ese 



d C/AFCC or S6i ) assistance 
> as Well (see page 7). 
-for -federally -funded recipients.) 

services may vary -from s+dte. to state. 




) specif endows setwiies y% 

or &PSOT (63rly Periodic* Screening^ Q\S£r*o£\s 3*6 Treatment) 

programs including -- 



— +© ekeck- 

• Vision • Nutrition, growth 
and development • Hearing 

• Dental health 

Eyeglasses, hearing aids, 
dental care are paid for if 
needed. 




—to deteet 

■3r»y P'^&AS&S, £,odk as— 

• Heart or kidney disease • Tuberculosis 

• Venereal disease • Ear, eye, nose, throat 
disorders • Anemia and sickle cell anemia 

• Parasites (worms, etc.) • Lead poisoning 

• Drug abuse 

Treatment is paid for if needed up to the 
limits of the state's program. 



to protect children 
against measles, polio, 
whooping cough, diph- 
theria, smallpox, etc. 





C7i^6HASi5 a*d f94,t#t*U>X 

programs to find and 
correct any problems 
before they result in 
permanent disability. 




J 



u 







OTHER fA£0f CM* &£&&&£& 

covered by ^ome frf-ate Medicaid ph*&, -tl^ougU 

K>of required by -federal 3uideJin£^: 



PP6SCPJPTIOH PPU65 



Covered for AFDC and 
SSI patients only in -- 



Alabama 


Nevada 


Arizona 


New Jersey 


Colorado 


New Mexico 


Delaware 


Ohio 


Florida 


Oregon 


Georgia 


Pennsylvania 


Idaho 


South Carolina 


Indiana 


South Dakota 


Iowa 


Texas 


Mississippi 




Missouri 






Covered also for 
"MEDICALLY NEEDY' 



in -- 



Arkansas 
California 
Connecticut 
District of 
Columbia 
Guam 
Hawaii 
Illinois 
Kansas 
Kentucky 
Louisiana 



Maine 
Maryland 
Massachusetts 
Michigan 
Minnesota 
Montana 
Nebraska 
New Hampshire 
New York 
North Carolina 
North Dakota 
N.M. Islands 



Oklahoma 

Puerto Rico 

Rhode Island 

Tennessee 

Utah 

Vermont 

Virgin Islands 

Virginia 

Washington 

West Virginia 

Wisconsin 






P6^f/\t services 



Covered for AFDC and 
SSI patients only in -- 



Florida 

Indiana 

Iowa 

Missouri 

Nevada 

New Jersey 



New Mexico 
Ohio 
Oregon 
Pennsylvania 
South Dakota 




NOTE: Some other states provide 

emergency dental services only. 



Covered also for 
"MEDICALLY NEEDY" in 

Arkansas 

California 

Connecticut 

Hawaii 

Illinois 

Kansas 

Louisiana 

Maine 



Maryland 


N. Mariana 


Massachusetts 


Islands 


Michigan 


Puerto Rico 


Minnesota 


Rhode Island 


Montana 


Utah 


Nebraska 


Virgin Islands 


New Hampshire 


Washington 


New York 


West Virginia 


North Carolina 


Wisconsin 


North Dakota 





eveGiflsses 



Covered for AFDC and 
SSI patients only in -- 



Alabama 

Alaska 

Arkansas 

Florida 

Indiana 

Iowa 

Missouri 



Nevada 
New Jersey 
New Mexico 
Ohio 
Oregon 
Texas 



Covered also for 
"MEDICALLY NEEDY" in 



NOTE: Some other states provide 

eyeglasses only after eye surgery. 

In some states, these services may also be covered for certain groups 
of people in institutions; people who are eligible for AFDC or SSI -- but 
have not applied; and others described on p. 7. 



Arkansas 


Maine 


North Dakota 


California 


Maryland 


Pennsylvania 


Connecticut 


Massachusetts 


Northern Mariana 


District of 


Michigan 


Islands 


Columbia 


Minnesota 


Rhode Island 


Guam 


Montana 


Utah 


Hawaii 


Nebraska 


Virgin Islands 


Illinois 


New Hampshire 


Virginia 


Kansas 


New York 


Washington 


Kentucky 


North Carolina 


West Virginia 
Wisconsin 



10 






Here 3"e Some. 
o\ke* .services 
your ,5+3+e nr»3y 
Qj&jQX -for 30fiA& 
or pill, IHe6'>i3i<} 
recipients. 



ethics 




HEALTH 
TT 



P9L05TH6TIC' 

such as pacemakers, 
artificial limbs. 



© , . 





POO/* 




oPtoi*£t*j£T5 







CHif^opAACfop-s, 




A*ej*TAU 

H05P»TAUS 

or psychiatric 
hospitals. 



CAM- FAdUTi66 






r 



tp^^OpJIL 





^Wg) 




&HEC4C w'«+k your local publ»o r»eal-t-U 
or Social service office -+o see wta-f- 
s>ervices your sfa+e co\/£rs. 



Medicaid 

3rJ Mftdi fc3re > 

dif-ferenC'e' 



M6PICAIP 

A&S«'Sf3r«C*e Pr^ram 

Medical bills are paid from 
federal, state and local tax 
funds. 



1+ $erve& loW- 



income. people. 



Q^G) 



^ 



f ^ 



^ 



^ 



p9+;e**4s oso^lly p9y 
flo PAW of costs 

for covered medical expenses. 
A small co-payment is sometimes 
required. 

A fe06(LfiL-&rpxe program, 

it varies from state to state. 
It's run by state governments 
within federal guidelines. 




J*6Pie|tR€ 

Insurance Pro$rdrr\ 

Medical bills are paid from trust 
funds which those covered have 
paid into. 

1+ Series people, Q Q 

€»&*- 65 primarily, f ''{ f ^ 
whatever their income; I fej ' 
and serves younger uf J 

disabled people and W ' 

dialysis patients. 



Patients flay PAWof cos+s 

through yearly deductibles for 
hospital and other costs. Small 
monthly premiums are required 
for non-hospital coverage. 

A P£P6£AU program, 

it's the same everywhere in the 
U.S. It's run by the federal govern- 
ment. 







Some, pe\op\e, *&re, &&/eseJ by 
botr* Medicare ^d /Medicaid . 

Medicaid pays their Medicare 
premiums and deductibles. It also 
pays those parts of medical expenses 
not covered by Medicare but included 
in the state's Medicaid program. 



17- 



etiGiBiury 



i»>eoMe umels 

-for el 131b; lify 

determined 



EACH STATE sets a figure 
for the minimum cost of the 
basic necessities (adjusted 
for family size). 

Those whose available 
family income is beneath 
Medicaid standards may be 
eligible. 




1& -tl*ere ^ 

Re&ip6i*ey 
P£4uif2£fiet>r 



ANY RESIDENT of a state may 
qualify for Medicaid. It is not 
necessary to live in the state for 
a set period of time, but the in- 
dividual must intend to remain 
in the state. 



People who travel often should 
apply in the state where they 
usually live, and to which they 
intend to return. 



This will NOT generally affect 
your eligibility. 

Usually a house or automobile 
of reasonable value and limited 
amounts of other property are 
not counted in determining 
income level. 



)3 



Wore CfjQ,&t\ov\& 

^d -answers — 



In general, at the end of the 

month in which a change of 

circumstance makes a person 

ineligible. 

Some exceptions: 

• AFDC families whose 
earned income rises 
above eligibility level 
are covered for 4 months 
after AFDC payments 
stop. 

• Disabled recipients who 
return to work can get 
temporary continued 
coverage until it is de- 
termined they are really 
able to support them 
selves. 





Medicaid has been abused by 

• recipients lying about income or 
circumstances 

• physicians charging for services not 
given or billing recipients for services 
paid for by Medicaid 

• hospitals giving more expensive 
services than ordered, etc. 



An estimated 5% of 
Medicaid expenditures are 
wasted on fraudulent or 
unreasonable payments. 
Tighter management and 
stricter investigation should 
cut losses in the future. 
Report any irregularities to 
your state's Medicaid office. 



/4- 



So % : $ WHAT? 




O— 



• bWGS Gooo HEfiMH CAP£ 

to millions of Americans who 
would suffer without it. 

• y*ei,p& w&w- th£ vicious dP-eue 

that keeps the poor sick and 
the sick poor. 

through early detection and 
treatment of disease, especially 
in children. 




Medicaid ben&fite gll of vs 
by irv>pro/tng -fke> 'av-aitabili+y of 

ke^l+U .S&rvie&S in-tta U.5. 



15 



CMS LIBRARV 




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